Abstract
OBJECTIVE: In the context of scientific uncertainty, treatment choices for localized prostate cancer vary, but reasons for this variation are unclear. We explored how black and white American men made their treatment decision. METHODS: Guided by conceptual model, we conducted semistructured interviews of 21 American (14 black and 7 white) men with recently diagnosed localized prostate cancer. RESULTS: Physician recommendation was very important in the treatment decision, but patient self-perception/values and attitudes/beliefs about prostate cancer were also influential. Patients who chose surgery believed it offered the best chance of cure and were more concerned that the cancer might spread if not surgically removed. Patients who chose radiation therapy believed it offered equal efficacy of cure but fewer side effects than surgery. Fear of future consequences was the most common reason to reject watchful waiting. Anecdotal experiences of family and friends were also important, especially in deciding "what not to do." The new technology of robotic-assisted prostatectomy provided optimism for men who wanted surgery but feared morbidity associated with traditional open surgery. Few men seemed aware that treatment did not guarantee improved survival. CONCLUSION: Most men reported making "the best choice for me" by taking into account medical information and personal factors. Perceptions of treatment efficacy and side effects, which derived mainly from physicians' descriptions and/or anecdotal experiences of family and friends, were the most influential factors in men's treatment decision. By understanding factors that influence patients' treatment decisions, clinicians may be more sensitive to individual patients' preferences/concerns and provide more patient-centered care.